All eyes are on the 70th UN World Health Assembly in Geneva from 22-31 May, as all 194 member countries will vote on the next director-general of the World Health Organisation (WHO) – the first time the vote is open to the assembly’s entire membership instead of just the executive board.

As current WHO director-general Margaret Chan steps down on 1 July 2017, the candidate to be installed into office will have a huge task ahead. He or she will be expected to implement some changes and address problems that Chan failed to – such as the suffering in the recent 2014 Ebola epidemic in West Africa that WHO has disingenuously downplayed as “too-sensitive” and failed to use its power to declare it an international health emergency for more than four months.

There are also global health challenges such as the lifestyle conditions like cancer, heart disease, diabetes and chronic respiratory diseases; along with the growing problem that is mental health. Old infections are also re-emerging and new pandemics raise alarm, along with the increased resistance to life-saving antibiotics.

The biggest irony is that medical science has been advancing tremendously, yet health inequalities are widening. It emphasises the need for change in leadership and direction. Extra funding has always been welcome to expedite research and development but experts say the revolution in mind-sets and attitudes is more important.

Current WHO has placed funding in different priorities

WHO no doubt, has been successful in curbing many infectious diseases and addressing global health issues. Nonetheless, the organisation is still heavily criticised for its costly, many-layered, self-serving bureaucracy that is unresponsive to real country needs.

Recently, reports showed it routinely spent about USD200 million annually on travel – far more than what it allocates to fight some of the biggest problems in public health such as AIDS (USD71 million), tuberculosis (USD59 million) or malaria (USD61 million).

This has angered many countries as the agency requests for increased funding to respond to health crises worldwide. Senior officials have also complained internally that UN staff members are breaking the rules by booking business-class airplane tickets and stays in five-star hotels.

Therefore health experts hope the next candidate should be able to carry out organisational changes to drive universal health coverage, foster collaboration, strengthen national health capacities and forge partnerships that respect health as a fundamental human right.

Meet the candidates who are big on global health

Tedros Adhanom Ghebreyesus is a non-medical doctor trained in the immunology of infectious disease and community health, and former health and foreign affairs minister from Ethiopia.

He is also a widely respected malaria researcher and a strong believer in strengthening health systems and universal health coverage – with a solid track record further cementing his credentials.

Ghebreyesus has helped install the delivery of basic health services in Ethiopia through the “health extension workers” program that deploys two salaried health workers to each village. The program has been credited to decrease child mortality and improve maternal health in the country.

In contrast Sania Nishtar – a trained cardiologist and former health minister in Pakistan – has been recognised for a list of notable achievements. She was co-chair of the WHO’s commission on ending childhood obesity and founder and president of the think-tank Heartfile, a non-profit NGO that focuses on policy analysis and solutions for improving Pakistan’s health system.

More of a policy-reformer, Nishtar has utilised her many professional roles – as well as her civil society and academic work – to reform policies on health and non-communicable diseases. She has been nominated to strengthen health systems, global health and broader issues of governance and public-private relationships to the role.

WHO veteran David Nabarro on the other hand, has worked on the Sustainable Development Goals (SDGs), food security and health emergencies, focusing on child health and nutrition programmes in South Asia, East Africa and Iraq.

Also medically trained, he is currently special advisor to the UN secretary-general on sustainable development and climate change. Nabarro said his four priorities are aligned with the SDGs, responding to emergencies and outbreaks, trusted engagement with member states, and people-centred health policies.

A huge task ahead

All three candidates have promised similar things such as leadership, improving WHO capabilities, transparency, and coordination and funding, but the issues of divisions between regional and country systems, bureaucracy and budget need to be addressed as well.

A balance must be struck within an environment of competing priorities and highly politicised views of member states, industry and advocacy groups.

“The role will require technical ability, administrative leadership, diplomacy, integrity and prowess,” said Sonia Allan an Associate Professor on Health Law at Deakin University, “All three are highly accomplished global health leaders, which bode well for the future direction of the WHO.”